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Defining safe criteria to diagnose miscarriage

Read the full open access article: http://www.bmj.com/content/351/bmj.h4579 Current national guidelines on the diagnosis of miscarriage may still be associated with misdiagnoses, and should be reviewed in light of new evidence, suggests a study published in The BMJ today. The Royal College of Obstetrics and Gynaecologists (RCOG) guidelines recommend a miscarriage diagnosis based on an ultrasound scan measurement of the gestational sac diameter (GSD) and the embryo's crown-rump length (CRL). Guidelines on the cut off values for these measurements were updated in 2011 following concerns that the older recommendations were based on inadequate evidence and leading to misdiagnoses. These changes have been shown to be safe, according to a new study by Professor Tom Bourne at Imperial College London and colleagues. But they argue that the guidelines now also need to be updated with new criteria for when the initial scan is inconclusive and a repeat scan is needed, as a result of the embryonic and gestational sac sizes being too small. A repeat scan is recommended, usually 1-2 weeks later, but this guidance is based on expert opinion rather than evidence. So the team of authors also set out to determine new recommendations for the second scan. They examined the ultrasound scans of 2,845 women admitted to seven early pregnancy units in the UK during 2011-2013. Women were admitted due to vaginal bleeding, pain, severe morning sickness or a previous miscarriage or ectopic pregnancy. Based on the examination of these ultrasound scans, the authors make specific recommendations for a repeat scan between 7 and 14 days after the initial scan depending on the size of the GSD, CRL and presence or absence of a heartbeat.